1558403980 NPI number — LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB., P.C.

Table of content: (NPI 1558403980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558403980 NPI number — LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWER MANHATTAN PHYSICAL THERAPY & SPORTS REHAB., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558403980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-0101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-571-3852
Provider Business Mailing Address Fax Number:
833-888-7868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 E 87TH ST # 405
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-2226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-249-0904
Provider Business Practice Location Address Fax Number:
646-527-9021
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WATERS
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-654-3212

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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